Provider First Line Business Practice Location Address:
16 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
03909-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-351-8117
Provider Business Practice Location Address Fax Number:
207-351-8098
Provider Enumeration Date:
05/03/2013